depression

I’m an emotional eater – it doesn’t matter if I’m feeling bad or good. But when I’m depressed I crave sugar & carbs. I’ve always conveniently blamed my father. I’m not sure whether he was the one who needed a pick-me-up or he thought I did but he would go out of his way to bring a bit of pleasure into my life in the form of something delectibly sweet.

Dad would drive across town to a special shop that dispensed root beer from a soda fountain and then back at home he’d pile in vanilla ice cream to make floats. We would sneak out to eat cinnamon rolls and M’M’s peanut chocolate candy.

Dad lived by specific culinary principles:

Cake’s main purpose was to hold up the frosting.

Pepsi was the beverage of choice because water was for bathing, not drinking.

The only edible food was brown and white (unless it contained copious amounts of sugar), green food should be reserved for insects or chimpanzees

Fruit was only safe to eat if it was in a pie.

Today there is a an incredible amount of scientific evidence that food is medicine, not just muscle fuel, and the right kind of diet may give the brain more of what it needs to avoid depression, or even to treat it once it’s begun

You’re feeling depressed. What have you been eating?

Psychiatrists and therapists don’t often ask this question. But a growing body of research over the past decade shows that a healthy diet—high in fruits, vegetables, whole grains, fish and unprocessed lean red meat—can prevent depression. And an unhealthy diet—high in processed and refined foods—increases the risk for the disease in everyone, including children and teens.

The findings are spurring the rise of a new field: nutritional psychiatry.

“Now recent studies show that a healthy diet may not only prevent depression, but could effectively treat it once it’s started.“Researchers, led by epidemiologist Felice Jacka of Australia’s Deakin University, looked at whether improving the diets of people with major depression would help improve their mood. They chose 67 people with depression for the study, some of whom were already being treated with antidepressants, some with psychotherapy, and some with both. Half of these people were given nutritional counseling from a dietitian, who helped them eat healthier. Half were given one-on-one social support—they were paired with someone to chat or play cards with—which is known to help people with depression.”

“After 12 weeks, the people who improved their diets showed significantly happier moods than those who received social support. And the people who improved their diets the most improved the most. (The study was published in January 2017 in BMC Medicine).”

“A second, larger study drew similar conclusions and showed that the boost in mood lasted six months. It was led by researchers at the University of South Australia and published in December 2017 in Nutritional Neuroscience.”

“And later this month in Los Angeles at the American Academy of Neurology’s annual meeting, researchers from Rush University Medical Center in Chicago will present results from their research that shows that elderly adults who eat vegetables, fruits and whole grains are less likely to develop depression over time.”

Decades ago, when every one of the ten thousand doctors I saw(ok, so I exaggerate . . a bit) pronounced me “fit as a fiddle” despite the crushing pain, depression and fatigue I was experiencing. I decided the only explanation was my body was inhabited by alien creatures. Turns out my diagnosis may have been close to the truth.

“As researchers turn their microscopes to these hidden environments, they have discovered something remarkable: There’s an entire ecosystem of bacteria and a vast neural network operating in our guts. This ecosystem is our second brain, and comprises some 100 million neurons, more than the spinal cord. This is not a thinking brain—it does not reason, write poetry, or solve multi-linear regressions—but mounting evidence suggests that your gut’s health strongly influences your mood.”

“The enteric nervous system is a mesh-like network of neurons that lines the entire digestive track. It causes the sensation of nervous butterflies or a pit in your stomach that are innate parts of our psychological stress responses. Up to 90 percent of the cells involved in these responses carry information to the brain rather than receiving messages from it, making your gut as influential to your mood as your head is. Maybe even more.”

Even crazier is that our second brain is actually only half of us. Inside the digestive system, the enteric nervous system mainly communicates with bacteria. These are completely separate creatures that make up our microbiome, and there are just as many of them inside of us as our own human cells.

“Our gut bacteria have evolved with us since birth. They help digest our food and fight off unfriendly outsiders like viruses and molds. To keep us healthy they need to be healthy and plentiful as well. When they’re not, we feel it: This biomass of bacteria communicates with important neurotransmitters embedded throughout our enteric nervous system to send messages that influence the way we feel.”

“This could herald good news for those who suffer from anxiety or depression. Studies indicate that those with healthy and diverse gut microbes are less likely to suffer from either malady. And many of us who grew up in too—clean environments, frequently took antibiotics, and ate junk food have a decidedly unhealthy microbiome. So changing one’s diet could well benefit far more than your waistline.”

“If you’ve seen the term “probiotics” recently, this is why. Probiotics are foods that nourish and promote your biome. They’re foods cultured with the strains of healthy bacteria. Yogurt is a cultured food. Unfortunately, many grocery store yogurts are little more than a thickened, sweetened milk product. But yogurt that lists strains such as Lactobacillus acidophilus and Bifidobacterium lactis actually contain the healthy bacteria your gut needs. “Prebiotic” foods, meanwhile, support a healthy gut ecosystem in which your bacteria can thrive. Together, prebiotic and probiotic food help keep your second brain full of the vibrant bacterial community it needs to function.”

I don’t know about you but I remember being told as a child: “Do your best”, “Try your best” and questioned: “Is that the best you can do?” I worried a lot that I wasn’t trying hard enough or I should have done better. Whether that led me to being a “perfectionist” (which some will dispute) I’ll never know. After reading about the neuroscience research what I do know is, from now on, I’m DECIDING to strive for GOOD ENOUGH.

Alex Korb, UCLA neuroscientist, maintains: One thing to try is making a decision about what’s got you worked up. It doesn’t even have to be the perfect decision; just a good one will do.

“. . . Trying for the best, instead of good enough, brings too much emotional ventromedial prefrontal activity into the decision-making process.”

“In contrast, recognizing that good enough is good enough activates more dorsolateral prefrontal areas, which helps you feel more in control …” Korb: “Actively choosing caused changes in attention circuits and in how the participants felt about the action, and it increased rewarding dopamine activity.”

Decisions, Decisions by Peggy

Making decisions includes creating intentions and setting goals:

Decisions, intentions & goals – all three are part of the same neural circuitry and engage the prefrontal cortex in a positive way, reducing worry and anxiety.

Helps overcome striatum activity, which usually pulls you toward negative impulses and routines.

Changes your perception of the world — finding solutions to your problems and calming the limbic system.”

“A key thing here is that you’re making a conscious decision, or choice, and not just being dragged to a resolution. Your brain gets no reward for that.”

“If you’re still reluctant to make a choice between one option or another, the science suggests don’t worry, you’re likely to gain a positive bias toward the decision you make anyway.”

I’m a hugger. I admit it. It’s almost a reflex when I see someone I like or admire.

In the 1970’s I taught 3rd grade. It was common for some students to run up, throw their arms around my waist and give me a big hug. We teachers would always hug back. When a student got hurt or was in distress a hug was automatic. Our cultural climate has changed and teachers are no longer suppose to touch, much less hug, students. Our cultural climate is continuing to change and unwanted, unwarranted “hugs” are rightly being brought out into the open and condemned.

“Got someone to hug? Go for it. Alex Korb, says ‘A hug, especially a long one, releases a neurotransmitter and hormone oxytocin, which reduces the reactivity of the amygdala.”‘

“Hand holding, pats on the back, and handshakes work, too. Korb cites a study in which subjects whose hands were held by their partners experienced a reduced level of anxiety while waiting for an expected electrical shock from researchers. “The brain showed reduced activation in both the anterior cingulate cortex and dorsolateral prefrontal cortex — that is, less activity in the pain and worrying circuits.”’

And if you have no one handy to touch, guess what? Massage has also been shown to be an effective way to get your oxytocin flowing, and it reduces stress hormones and increases your dopamine levels. Win win.

Mousey Masseuse by Peggy

The value of touching shouldn’t be overlooked when you’re down. According to Korb:

“In fact, as demonstrated in an fMRI [functional magnetic imaging] experiment, social exclusion activates the same circuitry as physical pain . . .”

“Stress-related disorders and diseases have been on the rise in the whole population for decades, according to data from the Centers for Disease Control and Prevention, including those leading to . . . deaths of despair, but also to heart disease, obesity, and diabetes.”

“National surveys by the American Psychological Association that also capture how stressed, anxious and overwhelmed we feel show a similar increasing pattern. And it shows up in our bodies, even before we get sick or start down the many roads to self-harm.”

a judy collage

I personally have experienced just that. My fibromyalgia flared for the first time during a particularly stressful time in my life. The truth is I didn’t realize how stressed I was at the time. Years later, it dawned on me that I had been in the center of “the perfect” storm of stressful circumstances: My aging parents and in-laws were dying; my work focused on anger, anxiety, depression – any and all forms of psychological tension or stress; and my own hormonal changes.

I’ve seen similar circumstances with many clients and colleagues who, like me, coped with and habituated to the level of stress they were under and often didn’t know the magnitude of impact until much later when they became ill.

All of us experience stress from work, money worries, traffic, political news, deadline pressure, relationship difficulties etc. and an even more basic cause which lies hidden at the intersection of psychology and biology:

Biology

“A central biological pathway is from excess cortisol — the fight-or-flight hormone — that characterizes being over-stressed for long periods of time. This “stress dysregulation” leads to risky health decisions, like addiction or overeating, and directly to many health problems linked to excess cortisol.”

Psychology

How we THINK triggers the stress response. We don’t have to actually be in a stressful situation – it’s our perception of it that alone can trigger a neuro-biological stress response.

Slow-moving and cumulative social forces “get under the skin” early in life and can show up decades later in morbidity and mortality.

Losing a sense of control that you believed you had, whether real or not, justified or not, creates stressful dislocations.

There are many things that can be done to “de-stress”. Most require time, money, effort or all three. Basically, we like what is quick and easy. To that end we’ve accumulated information and exercises over the 30 decades each of us was in practice and have now compiled some of it into a 19 page FREE PDF.

The Hamilton Projectlooked at the “physiological stress load” in the US using biological markers tied to cardiovascular, kidney and liver function to create a stress load index. This physical stress load, a precursor to many diseases, has increased in striking fashion since the late 1970s, and it is getting worse as each new age group enters adulthood.

The rosy pictures of family harmony is ever-present in the media during holiday season.

As therapists we were privy to the fact that holidays are stressful and often bring out the worst in family and interpersonal relationships.

Clients who had no family fantasized about what they were missing and clients with families fantasized about how to miss family gatherings.

Family Dynamics by Peggy

It’s gratifying to know we were on track with how we approached client holiday stress & strain. The research bears this out:

It is not helpful to ruminate on what was, what could be, ruminate over and over about the hurt, anger, injustice of it all. Rumination leads to depression and/or anxiety.

It’s best to tell the “tale” once, focus on what hasn’t worked and find new ways to cope.

Here’s a synopsis of the research and article:

Family Arguments Over The Holidays? Replaying Them in Detail May Be the Best Way to Cope

“Repeated studies have found that people prone to depression can get worse if they excessively dwell or ruminate on a stressful incident such as a quarrel or a loss. But experiments by Exeter University psychologists have found that when individuals practised running emotional incidents through their head, focusing on sensory details and recalling exactly what happened, how it happened, and even where it happened, it helped them respond constructively and stopped them becoming so upset about a future or past stressful experience.”

“Psychologists at the University of Exeter have found that recalling the detail of shouting matches and disagreements, including exactly who said what to whom and how, may not be destructive and prolong the tension, but could help people keep incidents in perspective and stop the triggering of self-doubt and even depression.”

“After training to recall the details of an upsetting incident including the tone of a voice, the words used and how the event happened, people became more resilient and put the upsetting incident into context, stopping a downward spiral into low mood.”

“The same exercise of focusing on the sensory details of sad experiences and asking “How did it happen?” “How can I do something about it?” was also found to speed up recovery from doing badly on a test in undergraduates, and to improve interpersonal problem solving, such as finding a way to make up with your partner after an argument, in people who were currently or formerly depressed.”

“For people experiencing depression learning to focus on stressful incidents and to re-imagine them in full technicolour asking themselves ‘What is unique about this situation?’ ‘ How did it happen?’ – instead of ‘Why did it happen to me? had an a ‘significant’ impact on helping to alleviate mental ill health.”

Then again, one way to avoid all the holiday tension is to eat out or . . . leave town.

Stanford University: “The lecture was on the mind-body connection – the relationship between stress and disease. The speaker (head of psychiatry at Stanford) said, among other things, that one of the best things that a man could do for his health is to be married to a woman whereas for a woman, one of the best things she could do for her health was to nurture her relationships with her girlfriends.

Meowie & Friends by Peggy

At first everyone laughed, but he was serious.

“Women connect with each other differently and provide support systems that help each other to deal with stress and difficult life experiences.Physically this quality “girlfriend time” helps us to create more serotonin – a neurotransmitter that helps combat depression and can create a general feeling of well being. Women share feelings whereas men often form relationships around activities. They rarely sit down with a buddy and talk about how they feel about certain things or how their personal lives are going. Jobs? Yes. Sports? Yes. Cars? Yes. Fishing, hunting, golf? Yes. But their feelings? Rarely.”

“Women do it all of the time sharing from our souls with our sisters/mothers, and evidently that is very good for our health. He said that spending time with a friend is just as important to our general health as jogging or working out at a gym.”

“There’s a tendency to think that when we are “exercising” we are doing something good for our bodies, but when we are hanging out with friends, we are wasting our time and should be more productively engaged—not true.”

The Health Factor– Women without strong social ties risk health issues equivalent to being overweight or a smoker – it’s that serious.

Interesting Research findings:

Longevity – Married men live longer than single men, yet women who marry have the same life expectancy as those who don’t. However, women with strong female social ties (girlfriends) live longer than those without them.

Stress – For decades, stress tests focused solely on male participants, believing that all humans would respond in the same manner. When these same stress tests were finally conducted on females it was discovered that women don’t have the same, classic ‘fight or flight’ response to stress that men do. According to the research presented in The Tending Instinct, women under stress have the need to ‘tend and befriend.’ We want to tend to our young and be with our friends. Time with our friends actually reduces our stress levels.

More Stress – A study conducted by the UCLA School of Medicine found that when we’re with our girlfriends, our bodies emit the “feel good” hormone oxytocin, helping us reduce everyday stress. By prioritizing our female friendships and spending time with these friends, we take advantage of a very simple, natural way to reduce our stress.

Self-esteem – A recent study by Dove indicated that 70% of women feel prettier because of their relationships with female friends. It’s no surprise that our self-esteem is highly influenced by our girlfriends; this is important to understand for girls as well as women.